ANNOUNCEMENTS

Hello. I am writing to update you on the things that have changed at Beyond Addictions, and the things that are still the same. Changes we have made were prompted by the economy. The Addiction Treatment Industry as a whole was affected with fewer private pay clients and those with insurance wanting to use those benefits. The good news for us is that our Outpatient Treatment Program has continued to do very well, but we have experienced a decrease in requested Counseling Services which necessitated a transition to using mostly consultant counselors. Under the attentive direction of our Program Director, Stacy Lange LCSW, and the integrity and dedication of our counselors Clark Caswell and Terri Weber-Harris, this transition has been very smooth. Stacy and Clark continue to be involved in Beyond Addictions as consultants and both have also started their own private practices. Stacy can be reached for Couples and Family Counseling by calling 503.644.8700 and Clark Caswell for Addiction Counseling and Evaluations at 971.255.1513. Dr. Seppala continues his Psychiatry and Addiction Medicine services here in the Beyond Addictions clinic.

Steve Peterson, LCSW CADC III, moved here from California last year and has been renting space from Beyond Addictions for his own Addiction and Behavior Therapy practice: www.addictionandbehavioraltherapy.com. When we moved to the consultant model, it was perfect to involve Steve in helping with Drug & Alcohol Assessments, facilitating group, family and individual Counseling.

Stephanie, our bookkeeper, has been terrific in helping our clients get reimbursement from their insurance companies. However, we know that in this economy it is important to also be able to offer the ability to accept insurance. We are currently speaking with several Doctors, in Psychiatry and Chronic Pain Management, who do accept Insurance regarding expansion of their practices into the Beyond Addictions clinic. We are also looking for additional Physicians to add to the clinic and when this is accomplished Beyond Addictions would move to the larger space we have across the hall. Because Beyond Addictions provides comprehensive services and has a successful Outpatient Program, we receive a large number of calls from those wishing to use insurance. Yes, we wish the economy had not taken the path it did, but in the midst of that we have come up with creative solutions which provided for a smooth transition to a new model and a new opportunity for clients wishing to use their insurance.

Another response to the economy is a change from mailing our newsletter to sending it out via e-mail. Our mailing list included almost 1,000 names so it has taken us several months to update our list with e-mail addresses. Many have missed our newsletter and we will now be back on our regular monthly schedule. Thank you for the continued opportunity to provide the services we all feel very passionate about. Sincerely, Melinda

Parity Bill Becomes Law

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

On Friday, October 3, 2008, President Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Bill. The passage of this bill into law is the culmination of years of effort to end discrimination against those with mental health and substance use disorders. In response to the passage of the bill Pete Domenici (R.-N.M.) said, “We are ushering in a new era of health care for those with mental illnesses. No longer will we allow mental health to be treated as a stepchild in the health care system. If you have insurance, then your mental health care must be equal to benefits you get for any other disease.” People with mental health and addictive disorders will now have access to the same type of insurance benefits they receive for physical illness.

The bill requires health insurance plans that offer mental health coverage to provide the same financial and treatment coverage offered for physical illnesses. It expands parity by including deductibles, co-payments, out of pocket expenses, coinsurance, covered hospital days, and covered outpatient visits. It also requires that medical necessity determinations and the reason for denials of coverage are made available to the public. It does not mandate that group health care plans provide mental health coverage and there is a small business exemption for companies of fewer than 50 employees. The effective date the requirements will go into effect, for most health plans, is January 1, 2010.

This bill is a solid start in ending the discrimination and stigma associated with addiction and mental health issues. It will make it much easier for people to obtain the treatment and care they need for these disorders. This bill will end the loophole in Oregon’s parity bill as those insurance companies with headquarters outside the state will no longer be exempt from providing this type of coverage.

I want to thank everyone who contacted their Senators and Representatives to support passage of this historic bill.

A summary of the bill can be found at Thomas.gov by searching the name of the bill. It was part of the financial rescue package.

Buprenorphine Maintenance

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

Our experience with buprenorphine maintenance has revealed this medication to be a very helpful tool in the treatment of opioid addiction. We have used a somewhat unique maintenance program, so it has been exciting to see people use it during outpatient addiction treatment and have successful transitions into recovery.

Maintenance treatment of opioid addiction is used around the world. It is primarily done with methadone, which is often prescribed for years if not for life. Maintenance treatment with methadone helps to eliminate use of the opioids, reduces psychosocial problems, reduces the risk of medical problems associated with IV drug use (HIV, Hepatitis C) and results in less illegal activity and increased employment. It appears that maintenance treatment with buprenorphine provides similar benefits. Unfortunately, many methadone programs provide limited addiction treatment and people are left entirely relying on the medication. Recovery from addiction using a 12 Step model is seldom emphasized.

We have taken a different approach, combining the standard use of buprenorphine with our outpatient addiction treatment program. As a result, people receive medication that allows for resolution of craving and prevention of relapse, while they are advancing their lives and learning to live without drugs and alcohol. We use the buprenorphine to help people transition into recovery. They are involved in the outpatient program, and attend 12 Step meetings. As a result they establish personal recovery programs and the confidence needed to remain abstinent. We also treat co-existing mental health problems during the maintenance treatment period, so psychological stabilization occurs as well.

After 6 – 8 months on buprenorphine, once good recovery has been established, we taper people off of the buprenorphine. This is always scary for the individual who has been using opioids, but has worked out remarkably well. They are tapered while attending treatment once a week so we can provide support and help them through the transition to a medication free state.

We have gone through this with several people who have had great success. They often request the taper before we bring it up. They tolerate the taper with minor withdrawal symptoms. They remain involved in addiction treatment and 12 Step programs. And they have remained abstinent from opioids without buprenorphine. This exciting use of a pharmacological intervention for addiction has resulted in more people staying in treatment and getting sober.

Recovery Month

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

Working in the addiction field provides ample opportunity to witness both the miracles of recovery and the stark reality of active addiction. Addiction can destroy lives, and our culture tends to be indifferent unless it affects someone close, or is an interesting, newsworthy story. Most people only give thought to addiction when it affects someone in their family or the story becomes a voyeuristic pursuit. Those of us who treat addiction recognize it for what it is: a devastating, chronic illness that fools people into thinking the alcohol or drugs are not the problem.

I get queried regularly by friends about someone they know with a problem. It is such a common illness that people tend to forget how awful it can be to experience it or to be in a family with active addiction. Everyone starts to feel crazy. To the causal observer it just seems like they should take care of it, as if it’s as simple as placing a cast on a broken leg. Why can’t that starlet just quit using drugs and get on with her life? Addiction is remarkably different. It affects the parts of the brain that normally function to prevent risk to our lives, resulting in continued use of drugs or alcohol that promotes repeated risk. It’s a perverse cycle, at a subconscious level, that is not fully recognized by the individual. They don’t know what is happening.

We see people who’ve lost jobs, family and all their favorite activities, but cannot stop doing the very thing causing the problem. And they don’t even enjoy it anymore. A common reason people do nothing about a friend or family member is the myth that they have to want help. Most people in the midst of addiction want help at some level, but the drug or alcohol supersedes their concerns and fools them into thinking they are doing fine, that the only relief they get from their real problem (spouse, work, stress…) is the drug. We can’t wait for them to seek help. The history of addiction treatment in this country is one of raising the bottom, helping people identify addiction earlier in the course of the disease and getting treatment before it becomes severe or tragic. Good treatment helps those people who can’t see it to open their eyes to the whole problem. We can make a difference early and save people the next worse consequence. Why should we wait for a job loss, a car accident or worse before we act to help those we love?

September is Recovery Month in the USA. Don’t let another friend or family member continue down the path of destruction without offering help. Don’t wait for them to recognize the problem, or to ask, for it may not happen. Bring attention to this vast problem. Learn more about it and determine resources that can be used to help others. Talk about your experience with addiction and shed some light on the misconceptions that keep so many people stuck in this cycle of self defeat.

Fun in Early Recovery

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

Early recovery is fraught with problems and difficulties. Most people get focused on the seriousness of recovery, and the daily disciplines necessary to prevent relapse become paramount. It’s not easy to stay sober after a life of addiction and it is necessary to prioritize the activities associated with recovery and devote oneself to them. Without this level of attention, abstinence can be tenuous. However, we still need to enjoy our lives.

In the midst of addiction people quit having fun. Daily use of a drug loses its excitement quickly, and it becomes a daily grind complicated by ongoing consequences, shame and guilt. The individual’s whole world revolves around obtaining and using drugs and alcohol, as a result those activities that we used to enjoy get left behind. Almost every interview I have with people entering treatment reveals the loss of interests, hobbies and the fun activities that brought them so much joy in the past. I recently met a guy who was a professional snowboarder and gave it up entirely due to his alcohol use. When I ask new people what they do for fun they often describe all of the things they used to do, in the past tense, because they are no longer participating in the fun and joy that life has to offer. Their lives have been narrowed by the power of the addiction and they usually have not recognized this tremendous loss.

Unfortunately, we tend to be slow to re-establish fun activities. We get sober and we get serious. Sobriety and the working of a recovery program become serious business. It’s as if there’s no time for fun, I have to stay sober. This is a mistake. We need to become re-involved in those activities that provided joy in the past, and develop new ones. The ability to experience joy is not lost, but can seem that way, until we pursue it again. A common misperception is that one can’t dance sober. Other people have never skied without smoking pot, and others have never had sex without drugs and alcohol. What a remarkable feeling to fully experience these wonderful activities in sobriety!

Early recovery is about change, so how about committing to something new and fun? It can be as simple as going to the beach, or as complicated as a new sport that requires lessons, like golf. What about taking dancing lessons? Samba anyone? There are so many things to choose from, the possibilities are endless. Grab some recovering friends and commit to enjoying your life. Get out and try something new or re-engage in a lost hobby, but don’t think that recovery is entirely about seriousness and discipline. Have some fun!

Limitation and Acceptance

Dr. Marvin D. Seppala, Medical Director, CEO
Beyond Addictions

In our last newsletter I initiated a discussion of spirituality and I would like to continue to address this important issue. Spirituality is not defined in the AA literature, yet is a paramount aspect of all 12 Step programs. The AA text states, “The spiritual life is not a theory. We have to live it.” In spite of its essence to a 12 Step recovery program, spirituality is left up to the individual to define. By design, 12 Step programs are as open as possible to various spiritual beliefs and interpretations which was done in an attempt to prevent religious bias from limiting participation. The absence of a definition of spirituality leaves some confused, but most find that it provides a more acceptable path to belief in something outside themselves.

In Not God - A History of Alcoholics Anonymous Ernest Kurtz wrote: “Because the alcoholic is not God, not absolute, not infinite, he or she is essentially limited. Yet this very limitation – from the alcoholic’s acceptance of personal limitation – arises the beginning of healing and wholeness.” This profound principle was established in 12 Step programs as spiritual. One must accept limitation, the disease state of alcoholism and addiction, and look outside oneself to begin the process of healing.

At 12 Step meetings one regularly hears the statement “my best thinking got me here.” This reveals the necessity of another way of thinking and being, accepting of limitation, and in effect it is a statement of recognition that the answer lies outside oneself. It is also a concept which is supported by neurobiological research that reveals the remarkable power that addiction has over the individual. 12 Step programs suggest that those with addiction accept that they have this disease and look outside themselves for the solution. Acceptance of this limitation, the inevitable human act of acceptance of imperfection, opens the door to recovery.

Hope and the possibility of change are recognized in this limitation as well. 12 Step programs are verbal traditions and the telling of one’s story is an essential act of healing, but not just for the individual story teller. Hope and healing are expressed for the newcomer by those who have accepted their limitations and have already addressed them in a successful manner. Hope is found in the powerful stories of those who have already sought a spiritual solution in 12 Step programs and are leading remarkably different lives as a result. And it is this hope that uplifts the individual when facing the truth of their own limitations.

These remarkable examples of success allow people to begin to safely look at themselves and outside themselves to consider the possibility of a spiritual solution. “Working the Steps” is synonymous with daily attention to one’s spiritual condition. The AA text states, “We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.”

Recovery through Surgery

When I had 5 years clean and sober I faced my biggest fear in recovery—needing another surgery. Prior to my sobriety, I spent more than 15 years in and out of the hospital for many surgeries and prescribed narcotics. Eventually I found I was well into my disease of addiction and the fall was hard. I spent 90 days in residential treatment. By the Grace of My Higher Power I have maintained my Sobriety by my willingness to adhere to a Recovery Program that included AA, a Sponsor, and a strong 12 step program.

Recently, it was determined that I would have to under go three very complex surgeries in 4 months. I turned to my program of Recovery to overcome my fear of facing surgery, pain, narcotics and months of possible complications.

The first thing I did was increase my attendance at AA meetings. I spoke up, shared and let other recovering people help me work through it. I involved my sponsor and discussed a plan to keep me safe.

The second thing, I involved a medical team, including my surgeon, some nursing friends, my friend an Addictionologist, and my husband. As a recovering alcoholic and addict, it was very important that I have nothing to do with managing or dispensing my pain medications.

I learned so much from this experience. I learned that when narcotics are taken as ordered, they help the pain! I was so afraid that they would awaken the beast lying in wait for me. I was taught the difference between addiction and dependence. I also came to believe that I didn’t have to suffer because I was an addict. I learned to be honest about my pain needs. In the past my pain was maximized, now I had more challenges in being honest about my pain.

During these long trying months I did have several complications. There were times I became discouraged, I pressed in closer to my program and the counseling that I had in place. Until I was able to get out to meetings, some wonderful AA women brought AA meetings to my bedside.

Now the time came that I had one last mountain to climb. I had been on monitored pain medications and, as was inevitable, my body was dependent. My surgeon turned over my care to a wonderful clinic called Beyond Addictions that helped me detox from the opiates. Make no mistake it was tough! How did I do it? By NEVER, NEVER forgetting or doubting how much my sobriety means to me; by NEVER, NEVER forgetting my desire to stay present for me first, for my husband and my children. I never want to lose the connection recovery gave me to my Higher Power, whom I call God.

Today I am back to work, living life, and healing more every day. Today I am drug free; therefore truly free to be me!